Healthcare Provider Details

I. General information

NPI: 1518025287
Provider Name (Legal Business Name): NEEKA A MINOR PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 02/17/2021
Certification Date: 02/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 MAIN ST
WINDSOR CO
80550-5132
US

IV. Provider business mailing address

1511 FLORIDA DR
LOVELAND CO
80538-2440
US

V. Phone/Fax

Practice location:
  • Phone: 970-315-7465
  • Fax:
Mailing address:
  • Phone: 970-222-1471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number7141
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number7141
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: